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Upper Cervical Manipulation For The Treatment Of Cervicogenic Headache

The “typical New Yorker” works 8+ hours per day sitting behind a computer screen, and this can create poor postural habits in the neck and lead to pain and several different pathologies. In a recent study, I performed a simple questionnaire to 50 people (who I had never treated for neck pain) and found that 84% of these people often experience neck pain. They also admitted to having poor to fair postural habits. What I DIDN’T mention was that these 50 people were also asked if they did indeed experience neck pain, then did they also experience headaches and/or jaw pain. Out of the 42 people who experienced neck pain, 80% experienced semi-frequent headaches and 48% experienced jaw (TMJ) pain. It is well known that hyperextension of the subcranial region causes compromise to the suboccipital space and can compress the vertebral arteries, leading to “cervicogenic headaches.” However, most people who don’t extensively study arthrokinematics don’t know the exact changes that occur to the upper cervical spine, nor the proper way to solve the problem. Sometimes when postural habits have been forming for years and years, telling some to “sit up tall with their shoulders back and their chin in” doesn’t exactly work. This is why:

With repetitive or prolonged upper cervical hyperextension involved in a forward head posture, there can be basic adaptive shortening of the posterior cervical soft tissue structure. There can also be a progressive change in the joint capsules, leading to positional changes of C1 and possibly C2. The typical forward head posture involves a pattern of increased thoracic kyphosis with scapula protraction and humeral internal rotation. Also, there is flexion of the mid cervical spine with extension of the upper cervical spine. In this occurrence, C1 gets positioned (or “stuck”) too far posterior as the occiput is positioned anteriorly with respect to C1. In order for someone to reverse their habit of hyperextension of the upper cervical spine, C1 needs to be able to glide anteriorly so the occiput can roll posteriorly and perform the physiological movement we know as a “chin tuck.” When someone proves to be HYPO-mobile with this arthrokinematic, I tend to begin with treatment techniques to relax the suboccipital musculature (such as using the vestibular-ocular reflex to achieve a contract-relax stretch) followed by performing manipulations to glide C1 anteriorly. The end result is hopefully a better ability for the patient to perform a forward nod of the upper cervical spine, and then we can follow this up with postural stabilization exercises to reverse their forward head postural habits.

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